The solution is to get pregnant with PCOS quickly
A rather scientific look at the hormones. That cause infertility in women with PCOS and some of the medications and the different treatments to get you pregnant. So, there are several hormones that have to work together to make sure that you not only produce a mature egg but then ovulate it.
The key players in your body that are making this happen are your estrogen, progesterone, FSH, LH & GnRH. Lack of developing eggs is caused when your FSH and your LH are off balance. This underproduction causes your ovaries to produce less estrogen and progesterone than they need to; which causes your testosterone than to spike.
Normally, these 3 hormones would play together and kind of balance each other out, but when you have an overproduction or underproduction of one, then it immediately causes the other ones to be out of balance since they’re not working in a synchronous system. The imbalance of SFH & LH causes your eggs never to mature and if there’s not a mature egg, then you’re never going to ovulate it and if you can’t ovulate it, then you can’t get pregnant. So, that’s what causes your body to be infertile.
Now, let’s go to the flip side and see what the things are that you can do to actually get yourself pregnant anyway. The first thing that’s worth noting is you should follow the general guidelines of no smoking, limiting your alcohol and getting into a healthy weight range. These are all just as important in women with PCOS, but obviously, losing weight and getting in a healthy weight range is the most challenging. Once you’ve made those changes, the next step is to see if you’re ovulating. If you’re not cycling on any sort of regular monthly schedule, you can go ahead and assume that your ovulation isn’t happening as well.
Although you can ovulate without having normal cycles, it’s very rare and regardless not cycling is a red flag and you should bring it up to your doctor. If you are cycling, you can’t automatically assume that you are ovulating as well, you need to prove that out. And one of the easiest ways to do that is to use OPK’s or Ovulation Predictor Kits. You can use these in conjunction with basal body temperature and cervical mucus tracking, but those methodologies are prone to error and bad interpretation of data, so you might as well just stick with the LH or OPK kits to see if you’re ovulating or not. Women with PCOS, often get false positive with OPK’s because our LH is much higher, so you’re going to need to test for a while to see what kind of your natural baseline test result is. Unlike pregnancy tests, LH or OPK kits take a little bit of interpretation; one line needs to be darker than the other line. And so, with women with PCOS, sometimes it’s really hard to tell since our natural baseline line can be a lot darker. Anyway, taking them for a few weeks in a row should give you a good idea of what your baseline is and whether or not you’ll ever peak and get a positive OPK.
So, if you’ve gone through and you’ve determined that you aren’t ovulating, now is the time to go seek help from a medical professional. You can start with your OBGYN, but we highly recommend just skipping that step and going to a reproductive endocrinologist. They’re going to be much more equipped to help you get pregnant and conceive. An OBGYN is really a doctor for before you get pregnant and while you’re pregnant; not that very critical while you’re trying to pregnant with PCOS stage. The good news is that 70% of women that go to a RE and get some simple interventions will ovulate again and of those women, 30% will end up getting pregnant within the first three months.
pregnant with PCOS
So, there’s a good chance that just by seeking medical help, getting one type of pill and taking it, you’ll start ovulating and you’ll be able to conceive. The other perk of going to a RE right off the bat is that your partner can get tested as well and I highly, highly, highly recommend that you go do that and get him tested before you go on any sort of medication; whether it’s Metformin or Clomid or Femara, you really should get him tested first to make sure you’re not dealing with dual factor infertility. You don’t want to pay for emotionally and monetarily fertility treatments only to find out that they were never going to work because you have a sperm issue. The first drug you might be offered is Metformin; which is a type 2 diabetes drugs. It makes your cells more receptive to insulin, thus eliminating the insulin resistance issues and sometimes that’s enough to get your hormones back in balance; just getting your blood sugars to get back with a normal range.
A word of caution; if you don’t get labs beforehand to prove that your blood sugar is high and a doctor just automatically prescribes you Metformin, you should probably look for another doctor. The most recent studies on Metformin in women with PCOS show that it doesn’t do anything if your blood sugar isn’t already high. The next thing that I caution you to be educated on and to advocate for yourself on is taking Femara or Letrozole before taking Clomid. Clomid is a very common fertility drug given out quite a bit. In and of itself, it’s totally safe, but in women with PCOS, it greatly increases your chance of having multiples; which is automatically a high-risk pregnancy.
So, we don’t want that. Femara and Letrozole have been proven to be much more effective as far as producing singleton pregnancies; which is always the goal. So, Femara and Letrozole are the next steps. If your blood sugar is fine and Metformin isn’t going to help you any, Femara is probably the next drug that your doctor is going to offer you. This drug just helps your eggs mature and get to a fully mature state so that your body then can see that they’re mature and ovulate them and your cycle can proceed as normal. It’s worth noting that if you don’t automatically cycle and you’re one of those people that don’t have a period at all, you’ll need progesterone to jumpstart your cycle and that’ll be the start of all of the cycles I’m about to talk about up until IVF.
So, once you have your cycle and you take your Letrozole, usually days 3 through 7, then you’ll check and see if you ovulated. You can do this with at-home ovulation kits or more likely, your doctor will order a blood test to check your LH levels a few days after you should have ovulated. If that comes back and you haven’t ovulated, the next step is to go to a Monitored Medical Injectable Cycle. For the sake of this video, I’m just going to refer to that as an ‘Injectable Cycle’ from now on. What happens during an injectable cycle is you get to your period, you go on Femara and Letrozole and then you go on Gonal-F injections; which is just a tiny at-home injection that goes right into your stomach; doesn’t hurt at all and it gives you a medication called Gonal-F; which helps your eggs mature even further if they didn’t respond to Letrozole alone. The downside of being on Gonal-F is that you must refrigerate the drug and you must take it exactly the same time every night, so that can kind of be a pain to be kind of chained to wherever your drugs are being stored.
pregnant with PCOS
The other downside is that you need to go in for monitoring every other day to make sure your ovaries aren’t hyper-stimulating and to know when to take your trigger shot; which is the last part of an injectable cycle. When your ultrasound shows that your eggs have mature to an appropriate size, they’ll have you do an HSD trigger shot to make your egg ovulate and then you carry on the cycle like normal and try to get pregnant and check in two weeks to see if that worked. If for some reason injectable cycle doesn’t work for you; either you don’t get pregnant or your body doesn’t respond to the drugs, the next step is either going to be an IUI or IVF. Honestly, an IUI isn’t likely to have much better results than an injectable cycle, because either one; your eggs weren’t maturing, so there’s no way they’re going to mature on just an IUI cycle or two; there’s something else wrong that needs to be investigated; either egg quality or sperm quality. The only reason we mention it is some insurance companies require that you go through a certain number of IUI cycles before you go through IVF cycles. This is the boring part where you need to go actually talk to your insurance company and see what will they cover and what will they not.
IVF is the last resort with women with PCOS and honestly, is usually only used when women with PCOS also have some sort of other fertility issues; whether that be endometriosis or male factor infertility. In summary, usually, women with PCOS have relatively high success rates just using Femara to trigger ovulation. After that, you would go into an injectable cycle and after that, if you needed to, you’d go into IVF. Most women with PCOS will end up conceiving some way or another, but it just depends on how many months of trial and error you have to go through to get there. Unfortunately, a lot of medicine and especially fertility medicine is just trial and error and you have to try something to see if it works before you go on to the next thing.
Just know that you’re not alone; there’s plenty of women going through this as well, as long as you seek the right resources. One of my favorite resources is the Beat Infertility podcast. Heather Hooman is the woman that runs that and she does a fabulous job of mixing wonderful, wonderful doctor advice and doctor interviews with success stories to keep you motivated and keep you battling your infertility.
Above all the information was enough for pregnant with PCOS.